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General NPI Number Information
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NPI Number | 1073997318
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Entity Type | Organization
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Legal Business Name | MINNESOTA INTERNSHIP CENTER
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 1821 UNIVERSITY AVE W SUITE #271
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City | SAINT PAUL
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State | MN
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Zip | 55104-2801
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Country | US
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Telephone | 651-288-3152
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Fax |
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Provider Business Mailing Address
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Address Line | 2233 UNIVERSITY AVE W SUITE #450
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City | SAINT PAUL
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State | MN
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Zip | 55114-1600
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. KEVIN BYRNE
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Credential |
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Telephone | 612-414-4458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number | 4102-07
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License Number State | MN
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